Bridging that gap: a qualitative study of perceptions of equality, diversity and inclusivity in colorectal surgery in the UK and Ireland

BACKGROUND

There is a growing recognition on the importance of equality, diversity and inclusion (EDI) within surgery and the need to diversify the surgical community and its various organisations, in a bidto reflect the diverse populations they serve. To create, sustain and encourage a diverse surgical workforce requires an in-depth understanding of the current makeup of key surgical institutions, relevant issues pertaining to EDI and appropriate solutions and strategies to ensure tangible change.

OBJECTIVES

Following on from the recent Kennedy Review into Diversity and Inclusion commissioned by the Royal College of Surgeons of England, the aim of this qualitative study was to understand the EDI issues which affected the membership of the Association of Coloproctology of Great Britain and Ireland, while seeking appropriate solutions to address them.

DESIGN

Dedicated, online and qualitative focus groups.

PARTICIPANTS

Colorectal surgeons, trainees and nurse specialists were recruited using a volunteer sampling strategy.

METHODS

A series of online, dedicated, qualitative focus groups across the 20 chapter regions were held. Each focus group was run informed by a structured topic guide. All participants who were given the opportunity to remain anonymous were offered a debriefing at the end. This study has been reported in keeping with the Standards for Reporting Qualitative Research.

RESULTS

Between April and May 2021, a total number of 20 focus groups were conducted, with a total of 260 participants across 19 chapter regions. Seven themes and one standalone code pertaining to EDI were identified: support, unconscious behaviours, psychological consequences, bystander behaviour, preconceptions, inclusivity and meritocracy and the one standalone code was institutional accountability. Five themes were identified pertaining to potential strategies and solutions: education, affirmative action, transparency, professional support and mentorship.

CONCLUSION

The evidence presented here is of a range of EDI issues which affect the working lives of those within colorectal surgery in the UK and Ireland, and of potential strategies and solutions which can help build a more inclusive, equitable and diverse colorectal community.

129 “Pop-Up” Specialist End of Life Ward For COVID-19—The Nottingham Experience

Background

Our hospital trust anticipated an increased need for palliation and end of life care (EoLC) in patients with Covid-19 who were not appropriate for escalation and mechanical ventilation.

Intervention

A dedicated ward was opened as part of the trust-wide Covid-19 admissions pathway, led by geriatricians with palliative care input and staffed by relocated nursing and auxiliary personnel. Retrospective data was collected for consecutive patients admitted to the ward between 3rd April and 26th May 2020 and qualitative data regarding staff experience using a questionnaire.

Result

Of the 168 patients (55% male) admitted, 31.5% came directly from Emergency Department, 17.3% from admission areas and the remainder from inpatient wards. Time spent on the ward ranged from 10 minutes to 17 days (median length of stay 43 hours). 75% had Clinical Frailty Scale score of 6 or more. 150 died with 75% naming Covid-19 as primary cause or contributing factor. Ward staff, who were not palliative care specialists, reported increased confidence in many aspects of palliation including assessing comfort, relieving symptoms, prescribing and administering anticipatory medications and in supporting and communicating with relatives. Staff apprehension about working on a Covid ward eased once the ward was established. Qualitative themes emerging from staff feedback included: professional competency, communication, prioritisation, team work, emotional response, care and consistency in a time of change.

Discussion

The pathway and referral system ensured that our ward cared for appropriate older patients living with frailty. The formation of a specialist unit over a short period of time created a series of logistical and management challenges. The emotional burden felt by staff was also prominent in feedback. These challenges were outweighed by the personal and professional development of staff coupled with the strong sense of teamwork, pride and enthusiasm felt in providing high quality care.

Establishing core outcome sets for gastrointestinal recovery in studies of postoperative ileus and small bowel obstruction: protocol for a nested methodological study

INTRODUCTION

Gastrointestinal recovery describes the restoration of normal bowel function in patients with bowel disease. This may be prolonged in two common clinical settings: postoperative ileus and small bowel obstruction. Improving gastrointestinal recovery is a research priority but researchers are limited by variation in outcome reporting across clinical studies. This protocol describes the development of core outcome sets for gastrointestinal recovery in the contexts of postoperative ileus and small bowel obstruction.

METHOD

An international Steering Group consisting of patient and clinician representatives has been established. As overlap between clinical contexts is anticipated, both outcome sets will be co-developed and may be combined to form a common output with disease-specific domains. The development process will comprise three phases, including definition of outcomes relevant to postoperative ileus and small bowel obstruction from systematic literature reviews and nominal-group stakeholder discussions; online-facilitated Delphi surveys via international networks; and a consensus meeting to ratify the final output. A nested study will explore if the development of overlapping outcome sets can be rationalized.

DISSEMINATION AND IMPLEMENTATION

The final output will be registered with the Core Outcome Measures in Effectiveness Trials initiative. A multi-faceted, quality improvement campaign for the reporting of gastrointestinal recovery in clinical studies will be launched, targeting international professional and patient groups, charitable organizations and editorial committees. Success will be explored via an updated systematic review of outcomes 5 years after registration of the core outcome set.

Healing and Medicine in the Aegean Bronze Age

Since the discovery of the Minoan and Mycenaean civilizations of Crete and Greek mainland, a systematic understanding has been gained of their material culture and social structures. Nevertheless, because of the absence of textual and pictorial evidence of medicine of the kind which exists in the contemporary societies of Egypt and the Near East, little work has been produced on the subject of disease and the practice of medicine in the period. However, new pathological evidence throws much light on this hitherto largely unknown aspect of their civilization.

Effects of Offenders' and Victims' Characteristics on Severity of Punishment

244 undergraduates read a transcript of a murder case, then made recommendations for treatment of the offender. In Exp. 1, length of sentence for a convicted murderer was unrelated to his mode of attire. In Exp. 2, sentences were unrelated to intention but were longer with than without a motive. In Exp. 3, punishment was not consistently related to the victim's gender. Suggestions for research are given.

Minoan and Mycenaean medicine and its Near Eastern contacts

Few scholars of ancient medicine have considered that Hippocratic practice may be based in part upon the experience and tradition, handed-down from generation to generation, starting before the end of the Bronze Age in 1100 BC. This paper examines the evidence for medical practitioners in the Aegean in the second millennium BC, and of medical contacts between the Aegean and contemporary bronze age societies of Egypt and the Near East at this time, and suggests that some of these contacts may have been the start of Near Eastern influence on Greek medicine.

The University of Birmingham Medical School and the history of medicine

The publication in 1993 by the General Medical Council of Tomorrow's Doctors-Recommendations on Undergraduate Medical Education provided the first real opportunity for many medical schools to advance the introduction of the history of medicine into the undergraduate medical curriculum. While the University of Birmingham Medical School, was not one of the first to introduce the subject, it has been at the forefront of the introduction of the history of medicine into the undergraduate medical curriculum since 1997, and can now boast a number of special study modules in the subject and the second largest intercalated BMedSc (History of Medicine) degree programme in the country. This article tells the story of why and how we introduced history into the curriculum and how important it is that tomorrow's doctors know something of the history of the profession they are about to enter.

Coronal suture response to distraction osteogenesis in rabbits with delayed-onset craniosynostosis

Recent studies have identified a subpopulation of persons with craniosynostosis who exhibit progressive or delayed-onset synostosis and mild cranial vault deformities. These persons may be good candidates for nonextirpation distraction osteogenesis. The present studies were designed to determine force-displacement parameters and assess the effects of distraction osteogenesis on coronal suture growth and morphologic characteristics in a rabbit model with congenital, delayed-onset craniosynostosis. Data were collected from a total of 178 rabbits: 71 normal controls; 16 normal controls with distraction; 72 with delayed-onset coronal suture synostosis; and 19 with delayed-onset coronal suture synostosis and distraction. At 10 days of age, all rabbits had amalgam markers placed on both sides of the coronal suture. In the force-displacement study, force-displacement distractors were placed across the coronal suture and distracted acutely for 1.0 mm at 42 days of age. Force-displacement curves for the coronal suture were best described by a third-order polynomial regression equation for both normal and synostosed groups. Significant differences (P < 0.05) were found in the mean force necessary to distract a normal suture 1 mm in distance (13.72 kg) compared with a suture with delayed-onset synostosis (48.39 kg). A significant (P < 0.05) relationship was also found between the extent of synostosis and the distractive force in rabbits with delayed-onset synostosis. In the distraction study, internal distractors were fixed across the coronal suture at 25 days of age and percutaneously and intermittently activated at an average of 0.11 mm/day for 42 days (4.54 mm total). Serial radiographs were taken at 10, 25, 42, and 84 days of age. Results revealed that rabbits with delayed-onset synostosis and distraction had significantly (P < 0.01) more coronal suture growth rates compared with rabbits with delayed-onset synostosis and no distraction. Coronal sutures were harvested at 84 days of age for qualitative histologic examination. Normal, distracted coronal sutures showed widened sutural ligaments and thin, active osteogenic fronts. In contrast, distracted coronal sutures from rabbits with delayed-onset synostosis showed narrowed sutural ligaments, thickened and blunt osteogenic fronts, and increased collagen and bony matrix deposition compared with controls. Results suggest that distraction osteogenesis without corticotomy may be a treatment alternative in persons with progressive, delayed-onset synostosis. However, these preliminary data also suggest that distractive forces may accelerate or stimulate osteogenesis differentially in persons with craniosynostosis, possibly through an underlying genetic disorder of bone and cytokine regulation. These differential osteogenic responses to distraction, if validated clinically, will need to be taken into account when planning distraction rate and rhythm protocols for patients with craniosynostosis.

Substance use among rural secondary schools in Zimbabwe: patterns and prevalence

OBJECTIVE

To survey drug use among rural secondary school students.

DESIGN

Self reported questionnaires developed by the World Health Organisation and translated into Shona were distributed to randomly selected students from 36 schools.

SETTING

Nyanga District secondary schools, Zimbabwe.

SUBJECTS

1,000 secondary school students, males and females, forms one to six.

MAIN OUTCOME MEASURES

Demographic variables, prevalence rates, frequency of drug use, first time usage, breakdown by age, sex and school type.

RESULTS

Alcohol was the commonest "ever taken" substance (34.9pc), followed by tobacco (18.5pc), solvents (6.9pc) and cannabis (34.9pc). Frequency of use was low and use of other categories of drugs was negligible.

CONCLUSIONS

Appropriate educational programmes need to be formulated and tailored to meet the needs of rural adolescents.

An overview of bilateral synchronous inferior petrosal sinus sampling (BSIPSS) in the pre-operative assessment of Cushing's disease

This study examines the role of bilateral synchronous inferior petrosal sinus sampling (BSIPSS) in resolving two major issues in the pre-operative assessment of Cushing's disease, namely proof of pituitary dependent disease and accurate lateralisation of tumour within the pituitary. BSIPSS was technically successful in 16 of 20 patients. The central to peripheral ACTH gradients, supporting the diagnosis of pituitary dependent disease, was greater than 2.0 (2.0-27.2) in all patients with histologically proven ACTH-secreting pituitary tumours and in those who remained in remission following pituitary surgery. In addition, BSIPSS accurately localised the site of the tumour within the pituitary in 13 of the 16 technically satisfactory studies and thus contributed to the outcome of surgical treatment. In contrast CT scan demonstrated a definite tumour in only two patients.

Clinical, biochemical and histological observations on the effect of porcine calcitonin in Paget's disease of bone

The response to porcine calcitonin has been assessed in 38 patients with Paget's disease, observed during 44 treatment periods of from three to 42 months. In 36 of the treatment courses significant relief of pain was achieved but the contribution of placebo effect could not be determined. Serum alkaline phosphatase and urinary hydroxyproline levels reached normal in a few patients, but the grouped data indicated a plateau effect above the range of normal. The acute hypocalcaemic response to calcitonin was lost only in those patients whose bone turnover was restored to normal. Quantitative histology on iliac crest bone biopsy samples showed no statisically significant lowering of osteoclast counts. No antibody-based clinical resistance occurred and the incidence of side effects was low. The results indicate that porcine calcitonin is a useful treatment of Paget's disease, and the experience of the study helps in arriving at patient selection and treatment schedules. Treatment is recommended for bone pain and for active disease in the relatively young, using intermittent therapy with course of at least six months duration. Resumption of therapy is based on clinical and biochemical indications.